Conjunctivitis

I see so many children wth conjunctivitis.  What a tempest in a teapot.  It’s most typically a very mild problem yet children are excluded from school pending me weaving my magic spell and putting the child on antibiotic drops.  Perhaps as a businessman I should think positively of school policies that mostly reguire a doctor’s evaluation prior to return as it brings in “customers.”  But being serious, if it disrupts my patients(not”customers”) lives and upsets their parents I’m not a great fan of that approach.  I guess its a “necessary evil”–to be sure and safe that school attendance does not place the rest of the students at risk.  So in come the little red eyed kiddies and I help wherever i can.

Anyway, pink eye is a symptom.  Most typically, it is a sign of a mild infection–occasionally bacterial but more typically viral–called conjunctivitis.   Usually the eyelids are slightly irritated and the eyes sting, burn, or may feel “scratchy”, but systemic symptoms like fever, headache, or vomiting occur less commonly.  Antibiotic drops will shorten the course in the case of bacterial infection but in most instances it will be a short term problem and will run its course in a few days at any rate.  Bathing the eyes with warm water, analgesics(acetaminophen or ibuprofen) for discomfort are usually all that is needed for treatment.  Vaporizer in your child’s bedroom, saline nasal drops, hot fluids to drink for nasal congestion can be helpful.  I don’t typically recommend medicines for cold/cough as I’ve detailed previously.

Please note that while “pink eye” is often synonymous with “conjunctivitis” they are not always the same thing.  Get poked in the eye or swim for a long time in a heavily chlorinated pool and your eyes will get pink but neither of those are infections, for example.  If your child has severe headaches or eye pain, photophobia(eyes sensitivity to light), change in visual acuity(eyesight deteriorating), or if the eye irritation and redness persist for greater than a week your child should be re-evaluated.

Please check in with questions or comments; thanks for following.

Teeth

A few words about your child’s teeth.  First teeth may typically erupt any time in the first 15 months of life.  A child can even be born with teeth(so called “natal teeth”).  Even before the first tooth, it is beneficial to gently wipe your baby’s toothless gums twice daily with a soft moistened washcloth.  Subsequently, use a soft toothbrush with a small brush head for the first erupting teeth.  It is probably best to not use fluoride toothpaste until your child is able to spit it out; a pea sized amount of paste is appropriate for a 3 year old.  Brush your child’s teeth–front to back– unitl he/she can hold the brush themselves and most children can brush unsupervised by age 6.

The American Dental Association now recommends that baby’s first dental visit should take place around the first birthday.  Don’t be discouraged if not much examining or treating occurs with these first visits–it’s fine to have your toddler sit in your lap and let your dentist do as much as his/her little patient will allow.  This will gradually “demystify” the process and will reap benefits in trust and cooperation at future visits.

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Temper Tantrums

Managing temper tantrums is a dreaded right of passage for all young parents with toddlers. Tantrums are inappropriate behaviors–crying, screaming, aggression towards others or even self–that a child may employ to express anger, frustration, sadness, or disappointment. They most commonly occur from 18 months-3 years(hence “the terrible 2’s “) although they can extend even to school age children ( truthfully, most of us still know a grown up or two who seem stuck in this stage!). They actual come about because of your toddler’s normal development as aspirations to control surroundings butts up against physical, intellectual, developemental, or emotional limits causing a failure to attain the desired result. So it certainly is “normal.”

Some risk factors–physical distress (tired, hungry, ill), emotional stress (new sibling,nursery school, ongoing/more severe parental illness or discord), disruptions of routine (eg. vacations). Hearing or speech delayed/impaired children can have more severe tantrums due to frustations caused by inability to understand or be understood.

Some (hopefully) helpful hints:

  • Adequate rest/meals-all of us are more prone to increased emotionalism when fatigued or hungry.
  • Be prepared-lots of tempers occur at predictable times eg. “stop your game and come to dinner.” Make sure you end that game before dinner, employ a “transition activity” eg. help with setting the table followed by a reward and promise to play the game after dinner together.
  • Patience- it’s best to ignore the behavior whenever possible and you can usually let it burn itself out. Calmly tell your child “we can talk about it when you calm down.”
  • Plan ahead–there are times/places when a tantrum cannot be ignored. Thinking ahead usually enables you to avoid them. For example if your toddler frequently has tantrums in the supermarket aisle, you need to try and arrange your schedule so you can food shop while another caregiver watches your child at home, bypassing the situation entirely.
  • DO NOT GIVE IN–In a perfect world( it’s not a “perfect world”) you never argue with a toddler. If you cannot win don’t have an argument and create a tantrum. For example you simply cannot force your child to eat so don’t have that argument. But your child cannot force you to give her dessert, so if she doesn’t eat her meal don’t argue there either even if she has a tantrum. No meal, no dessert-period.
  • Stick to routines–Children like routines. Explain to older toddlers beforehand what is happening, what is expected, and the rewards for cooperation. Be sure and follow through promptly with the positive reinforcement. This can head off lots of tantrums before they start.

Contact me for tantrums going past age 4, if they are prolonged (despite “ignoring them”), if they result in breatholding or violence causing injury. These are usually still of little consequence, but they should be discussed.

Please send along questions or comments and thanks for following.

Flu, vomiting, and dehydration

Vomiting is one of the more common symptoms of childhood illness.  Most often just a smelly mess, it can be evidence or the cause of serious problems.  What is the best approach to the vomiting child due to non-catastrophic illness, and when might we begin to worry more?

Vomiting caused by influenza(flu) or rotavirus (“stomach flu”–summertime) is caused by inflammation of the stomach and intestine from fever (“pyrogens”) in the bloodstream as well as primary irritation from the invading organsims into the lining (mucosa) of these organs.  Besides nausea and pain, more serious problems may arise from inability to absorb fluids and increased fluid losses.  Blood volume decreases, bloodflow to vital organs deteriorates and many metabolic derangements may develop.

Breaking the cycle of repeated vomiting is the goal we must address.  But don’t be too anxious to “just do something.”  The “magic formula” to settle the child’s upset stomach isn’t necessarily juice, broth, Pedialyte, or “just a sip of water” but time.

What can  we do?

  • Give a frequently vomiting child 3-4 hours of nothing consumed by mouth to allow his/her stomach to settle down a bit.
  • Subsequently begin approximately 1/2 oz (3 tsp only) clear liquids every 20-30 minutes for 2-3 hours.  As tolerated you may begin to gradually liberalize the amount taken up to “ad lib”–as much as desired over the ensuing 12-24 hours.
  • Next you may progress to a “BRATT” diet–bananas, applesause, tea, toast ( no dairy, milk, or meat).
  • You may give acetaminophen or ibuprofen for fever or discomfort when the child is more reliably able to hold down clear liquids.  (Note that acetaminophen is available as a rectal suppository and can be administered via that route to a vomiting child).

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